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Child Psychology Blogs

Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, April 21, 2020

Why No Knowledgeable Person Would Say Avoiding a Divorced Parent Means an Attachment Disorder

Five years ago, I wrote a post on this blog——where I expressed my concern about the attempts of the California psychologist Craig Childress to “explain” in terms of attachment theory why some preteen and teenage children avoid one of their divorced parents.

This parent avoidance phenomenon is sometimes referred to as “parental alienation” (PA), of course, and advocates of PA belief systems attribute the avoidance to skulduggery on the part of one of the parents, who maliciously turns the child against the avoided parent. As there is no adequate research and little theory about parent avoidance, there was a bit of room for Childress to put forth his take on it, which he did in a self-published book, a self-published pamphlet, a blog and a (now private) Facebook page.

Childress’s basic idea is that a child with a normal emotional attachment to a parent can have not only that attachment, but the whole “attachment system”, suppressed by the manipulations of the other parent. Why does that parent do the manipulating? Easy, according to this view; she (usually but not always) has a narcissistic/borderline personality disorder that has developed because she was in a condition of disorganized attachment as a toddler. That condition arose because one or both of the parent’s parents had been traumatized and hence behaved toward the child in ways that were both frightening and frightened.

None of these steps (except the source of disorganized attachment, if any) makes any sense in terms of what we know about attachment and later development. First, early attachment status is by no means a perfect predictor of later personality characteristics. A longitudinal study following individuals from birth to early adulthood showed that (Sroufe, 2005). Second, although there have been many queries about the outcome of disorganized attachment (a state in which toddlers behave strangely in circumstances where you would expect them to go close to a parent for comfort), the evidence seems to be that it does not result in a personality disorder. Third, even if a parent were able to suppress the child’s attachment system, logically this would interfere with all child-caregiver relationships and could not be finetuned to affect attitudes toward one parent and not the other. Fourth—and very important—children who avoid a divorced parent and are said to have PA are usually preteens or teenagers. Their ways of feeling and showing emotional attachment are vastly different from those of toddlers, they thrive without much parental presence unless some adverse circumstances disturb them, and in fact they are beginning to seek peers in friendship or romantic relationships that will soon replace the comfort and security that parents used to offer.

I said a lot of this about Childress’s views, a long time ago. Why bring it up again? The current problem has to do with discussions about the International Classification of Diseases published and periodically revised by the World Health Organization. The eleventh edition of this publication (ICD-11) is presently under construction, and a comment page allows interested people to propose and discuss various concerns. PA advocates, who failed to get PA included in DSM-5 in the United States, are hoping for some inclusion in ICD-11. The argument until just recently has been that PA cannot be listed as a diagnosis, but could be listed as an index term that would take the reader to the topic of “parent-child relationship problem”, obviously a category much broader than, and not necessarily including, PA.

In the last few days, however, it has been proposed that parent avoidance should be classified as an attachment disorder—and a few contributors have cited Childress as a source for this. One proposal lists criteria that are identical with lists of PA characteristics, but does not use the PA term.
So, could it make sense to think of PA as an attachment disorder? No, it could not. There are attachment disorders listed in both DSM-5 (and previous editions) and ICD-10. These are disorders of social relationships that appear to stem from a child’s history of caregiving and separations from caregivers; salient events in that history would have occurred during the period when emotional attachments usually form, about 10 months to 3 years of age. Reactive Attachment Disorder, for example, can only be diagnosed if there is a history of problematic caregiving in early life AND if symptoms begin before age 5 years.

Parent avoidance, on the other hand, is most often seen (and labelled PA) in children in the preteen and teenage years. The avoided parent usually states that the child was normally attached to him (or her) but now refuses contact. The early period when attachment forms is asserted to have been normal, and no problems or changes of caregiver are reported. These children are thus past the age when attachment disorders begin to show symptoms, and they do not have the problematic caregiving history associated with genuine attachment disorders.

What would be the advantage to PA advocates of claiming that attachment problems are the cause of children avoiding parents? One advantage is that there is a huge literature on attachment that authors may reference as supporting their thinking, as Childress frequently cites Bowlby. PA authors can be fairly sure that most of their audience, though they may have heard of Bowlby, actually have no idea what Bowlby said, when he said, to what extent he had an evidence basis, or to what extent he changed his mind. But everybody knows that attachment is good and attachment problems are bad, so this suggests that anyone concerned about a lack of attachment must be fighting the good fight.

Claims about attachment disorders may also win for PA advocates an added concern related to pseudoscientific views of known attachment disorders. Charlatans presenting their perspectives on Reactive Attachment Disorder, for example, have asserted that children with attachment disorders grow up to be antisocial, callous, cruel, even psychopathic. (Narcissistic/borderline, anyone? ) There is no evidence that this is true, but it would certainly be persuasive to a parent who knew no better.

Those who are proposing that PA be presented as an attachment disorder in ICD-11 are presumably hoping that their wolf will be accepted as a real sheep when wearing the attachment disorder disguise.  Fortunately, there are a number of knowledgeable people who want actual “wool and lamb chops” out of ICD-11 categories and are paying attention to these proposals.

Friday, April 10, 2020

Nonsense, Pseudoscience, and Parental Alienation

My other blog, which I’m afraid I’ve neglected for years, is called The Study of Nonsense. This phrase is a quotation from some brilliant person who has not been clearly identified. He said, memorably: “Nonsense is always nonsense, but the study of nonsense is scholarship”. I strongly agree with this comment and think it’s not well known how much scholarship is really needed to identify nonsense and show it to be what it is. If you don’t know what makes sense in a field, it’s hard to say what nonsense is. Nonsense can look perfectly plausible if you don’t know established relevant information and if you don’t examine arguments for plausibility.

Telling sense from nonsense is especially difficult when a topic involves many complex and interacting factors, which is the case for “parental alienation” (PA). The concept of PA is that when a child of divorced parents avoids contact with one parent, chances are strong that this occurs because the other, preferred, parent has manipulated or persuaded the child into taking that negative position. It would be foolish to argue that this never happens considering what very strange and undesirable things people actually do—but it would also be foolish to claim that a parent’s alienating behavior was the only cause for avoidance, even if such behavior were present. PA advocates do make that claim, however, even though one (Richard Warshak) acknowledges that there can be “false positives” in which a child is thought to  have been “alienated” when this is not the case.

The nonsense associated with PA can be hard to understand or explain because of these complicating factors. It may thus be more appropriate to talk about PA not in terms of ordinary nonsense, but in terms of pseudoscience. Pseudoscience is the name given to assertions that claim support from systematic scientific investigation, but do not in fact have such support. The issue here is “truth in advertising”, or, not to put too fine a point on it, the possibility of fraud. Pseudoscience is thus nonsense, but presents even more dangers to the public than forms of nonsense that do not make such claims.
There are a number of traits that allow us to recognize pseudoscience, and PA proponents have included most of them in their arguments.
·                     Exaggerated claims of effectiveness are made without support by adequate research
·                     Findings are misrepresented
·         The way a treatment is said to work is not congruent with well-established existing knowledge
·         Treatments have not been shown to work by a discipline’s usual standards of evidence, but are claimed to be effective anyway
·         Treatments have not only not been tested adequately, but are also based on implausible conceptual frameworks.
·                     Treatments are potentially harmful, either directly or in terms of side
·         Technical terminology is used to obfuscate rather than to clarify the discussion
I can provide examples for each of these as it applies to PA publications, but instead of doing that in this space I want to comment on an aspect of pseudoscience that is not often mentioned but that is quite relevant to the PA discussion. This is the addition of irrelevant information to material purporting to discuss PA issues. Tversky and Kahneman in 1981 demonstrated clearly that thinking is confused when people are presented with irrelevant as well as relevant information. For example, study participants who could effectively decide the probability that a person in a group was male or female after being told the proportions of each sex in the group, were nevertheless unable to solve the problem when additional information (like professions or hair color) was added--  even though the relevant information stayed exactly the same.

In a recent article supporting PA concepts,. Harman, Lorandos, Biringen, and Grubb (2019) gave an extensive list of mental and physical problems resulting from adverse childhood experiences (ACEs) without presenting any evidence that “alienation” by a parent was in any way equivalent to any of the ACEs. They thus coupled claims about PA with irrelevant (and frightening) material. Childress (2015) included in his self-published book many references to family systems therapy as discussed by authors like Haley and Minuchin, even though the treatment he recommended is not a form of family therapy and is stated to be successful even when many of the so-called “alienating” parents do not have any contact with their children until the children reach the age of 18. Childress also included in his discussion references to Tronick’s work on broken and repaired communication sequences but did not mention that the research involved infants and their mothers rather than the teenagers who are usually the focus of PA claims. The California psychologist Randy Rand, reported to be the originator of the PA treatment program Family Bridges ™ , claimed that he was asked to create this program by the National Center for Missing and Exploited Children, with the purpose of reuniting internationally-abducted children  with their American parents—a point of historical interest, but irrelevant to evidence supporting identification or treatment of PA.

The use of irrelevant information to confuse the audience is thus characteristic of PA publications and may be considered an aspect of pseudoscience.

When pseudoscientific thinking is part of the presentation of proprietary treatments for sale, the question of fraud arises. Whether a charge of fraud could be made to stick, of course, would depend upon whether a PA advocate actually believed in his or her assertions, and whether a victim could show that he or she had been harmed by PA practices.